Loubersac Thomas, Lavallée Etienne, Reiss Benédicte, Lefort Marc, Kieny Pierre, Leclair Marc-David, Rigaud Jérome, Le Normand Loic, Perrouin-Verbe Brigitte, Lefevre Chloé, Perrouin-Verbe Marie-Aimée
Department of Urology and Pediatric Urology Nantes Université, Centre Hospitalo-Universitaire de Nantes Nantes France.
Department of Pediatric Urology Nantes Université, Centre Hospitalo-Universitaire de Nantes Nantes France.
BJUI Compass. 2024 Oct 30;5(12):1269-1277. doi: 10.1002/bco2.449. eCollection 2024 Dec.
To show that robot-assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) is feasible and safe; however, data on clinical outcomes in adults are lacking.
We conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference centre.Patient characteristics, clinical information and perioperative outcomes were recorded. All patients underwent pre- and postoperative urodynamic evaluations.Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage.
Twelve patients, mostly women ( = 11), median (IQR) age 47.4 (19-57) years underwent RALCCUD (four Mitrofanoff, four Yang-Monti and four Casale). The main indication for surgery was inability to perform intermittent self-catheterization through the native urethra.Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism.Median (IQR) operative time was 313 (285-367) min. Four patients (33%) underwent concomitant procedures: three supratrigonal cystectomy (SC) with augmentation cystoplasty (AC) and one artificial urinary sphincter (AUS). No conversions to an open approach were required. Median (IQR) follow-up was 51 (40-61) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with three complications occurring in three patients.At the last follow-up, all patients could self-catheterize through the tube, and the stomal and urethral continence rate was 100%.
RALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.
证明机器人辅助腹腔镜可控性皮肤膀胱造瘘术（RALCCUD）是可行且安全的；然而，目前缺乏关于成人临床结局的数据。
我们对2017年至2022年期间在单一三级参考中心接受RALCCUD的所有成人患者进行了一项回顾性研究。记录了患者的特征、临床信息和围手术期结局。所有患者均接受了术前和术后尿动力学评估。在术后3个月进行功能结局评估，之后每年评估一次。控尿定义为无造口或尿道漏尿。
12例患者接受了RALCCUD（4例采用米氏法、4例采用杨氏法、4例采用卡萨利法），大多数为女性（n = 11），中位（四分位间距）年龄为47.4（19 - 57）岁。手术的主要指征是无法通过原尿道进行间歇性自我导尿。11例患者（92%）患有由脊髓损伤或脊髓发育异常引起的神经源性下尿路疾病。中位（四分位间距）手术时间为313（285 - 367）分钟。4例患者（33%）接受了同期手术：3例行三角区上膀胱切除术（SC）联合膀胱扩大术（AC），1例行人工尿道括约肌（AUS）植入术。无需转为开放手术。中位（四分位间距）随访时间为51（40 - 61）个月。发生了1例早期术后并发症（Clavien III级）。术后晚期并发症发生率为17%，3例患者出现了3种并发症。在最后一次随访时，所有患者都能通过导管进行自我导尿，造口和尿道控尿率为100%。
RALCCUD在成人中是可行且安全的，造口和尿道控尿率高，并发症发生率低。
